Lichen Planopilaris

Lichen planopilaris (LPP) is a type of autoimmune disorder that affects the hair follicles and causes hair loss, itching, and skin rashes. It is a chronic, progressive condition that can cause permanent hair loss if left untreated. The condition is most commonly seen in women in their 30s and 40s, but can affect people of all ages and both sexes.

Causes

The exact causes of LPP are not fully understood, but several factors have been identified as contributing to its development. These causes are classified into two main categories: genetic and environmental. In this article, we will explore each of these causes in detail.

Genetic Causes of Lichen Planopilaris:

  1. Inherited susceptibility: LPP is thought to have a genetic component, as it tends to run in families. The exact genes involved in the development of LPP are not yet known, but research is ongoing in this area.
  2. HLA antigens: Human leukocyte antigens (HLA) are proteins that are found on the surface of cells and play a role in the body’s immune response. Some studies have shown that people with LPP tend to have specific HLA antigens, suggesting a genetic link to the disease.
  3. Immune system dysfunction: The immune system is responsible for protecting the body from harmful invaders, but in some cases, it can mistakenly attack healthy tissue. This is known as an autoimmune reaction. In the case of LPP, it is believed that the immune system attacks the hair follicles, causing inflammation and hair loss.

Environmental Causes of Lichen Planopilaris:

  1. Chronic stress: Chronic stress has been shown to contribute to the development of autoimmune diseases, including LPP. Stress can weaken the immune system and make it more likely to attack healthy tissue.
  2. Exposure to UV radiation: Exposure to UV radiation from the sun can weaken the immune system and increase the risk of developing autoimmune diseases.
  3. Hormonal changes: Hormonal changes, such as those that occur during pregnancy or menopause, can weaken the immune system and increase the risk of developing autoimmune diseases.
  4. Infections: Certain infections, such as viral infections, can weaken the immune system and increase the risk of developing autoimmune diseases.
  5. Exposure to environmental toxins: Exposure to environmental toxins, such as chemicals and pollutants, can weaken the immune system and increase the risk of developing autoimmune diseases.
  6. Medications: Certain medications, such as those used to treat cancer, can weaken the immune system and increase the risk of developing autoimmune diseases.
  7. Age: The risk of developing autoimmune diseases, including LPP, increases with age.

Symptoms

The symptoms of LPP can vary from person to person, and can range from mild to severe. The following is a list of the most common symptoms of LPP:

  1. Hair Loss: One of the most noticeable symptoms of LPP is hair loss. The hair loss is typically patchy and can be accompanied by itching and red, scaly patches on the scalp.
  2. Scalp Itching: A frequent symptom of LPP is itching on the scalp. The itching can range from mild to severe, and can be accompanied by burning or stinging sensations.
  3. Scalp Rash: A red, scaly rash on the scalp is another common symptom of LPP. The rash can be itchy and may appear as raised, thickened patches on the scalp.
  4. Scalp Pain: Some people with LPP may experience pain on the scalp, especially when the hair is touched or combed. The pain can range from a dull ache to a sharp pain.
  5. Scalp Redness: The skin on the scalp may become red and inflamed as a result of LPP. This can be accompanied by itching and a burning sensation.
  6. Scalp Bumps: Small, raised bumps may appear on the scalp in some people with LPP. These bumps can be itchy and may be accompanied by redness and scaliness.
  7. Scalp Scaling: A flaky, scaly buildup on the scalp is a common symptom of LPP. This can be accompanied by itching and redness.
  8. Hair Thinning: In severe cases of LPP, the hair may become thin and brittle, and may break easily. This can result in noticeable hair loss and a decreased hairline.
  9. Nail Changes: In some people with LPP, changes may occur in the nails, such as ridges, brittle nails, and discoloration.
  10. Eye Changes: In rare cases, LPP may cause eye symptoms, such as dry eyes, redness, and inflammation.
  11. Systemic Symptoms: In rare cases, LPP may cause systemic symptoms, such as fatigue, joint pain, and fever.
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It is important to note that not everyone with LPP will experience all of these symptoms, and some people may experience symptoms that are not listed here. If you suspect that you have LPP, it is important to seek medical attention so that a proper diagnosis can be made.

Diagnosis

The diagnosis of LPP can be challenging, and several diagnostic tests may be required to confirm the condition.

Here is a list of diagnostic tests for Lichen planopilaris:

  1. Physical examination: A physical examination is the first step in diagnosing LPP. The dermatologist will examine the scalp, hair, and skin for any signs of inflammation, scaling, or hair loss. The doctor may also look for any signs of scarring, which can indicate that the hair follicles have been permanently damaged.
  2. Trichoscopy: Trichoscopy is a non-invasive diagnostic test that uses a special type of microscope to examine the hair and scalp. This test can help the dermatologist identify any abnormalities in the hair shaft or hair follicles, such as broken hairs, scaling, or redness.
  3. Skin biopsy: A skin biopsy is a procedure that involves removing a small piece of skin from the scalp for laboratory examination. The biopsy can help the dermatologist determine if there is any inflammation or scarring in the hair follicles, which can confirm the diagnosis of LPP.
  4. Blood tests: Blood tests can help the dermatologist rule out other conditions that may cause hair loss, such as anemia, thyroid disease, or autoimmune disorders. The dermatologist may also perform a test for antinuclear antibodies (ANA), which can indicate the presence of an autoimmune condition.
  5. Scalp biopsy: A scalp biopsy is a procedure that involves removing a small piece of tissue from the scalp for laboratory examination. The biopsy can help the dermatologist determine if there is any scarring or inflammation in the hair follicles, which can confirm the diagnosis of LPP.
  6. Phototrichogram: Phototrichogram is a test that uses a special type of camera to take images of the scalp. The images can help the dermatologist determine if there is any hair thinning or hair loss, and can also help identify any areas of scarring or inflammation.
  7. Wood’s lamp examination: Wood’s lamp examination is a test that uses a special type of ultraviolet light to examine the scalp and hair. The dermatologist will use the Wood’s lamp to look for any changes in hair color or texture, which can indicate the presence of LPP.
  8. Scalp MRI: A scalp MRI is a type of imaging test that uses magnetic fields and radio waves to create detailed images of the scalp. The MRI can help the dermatologist identify any abnormalities in the hair follicles, such as scarring or inflammation, which can confirm the diagnosis of LPP.
  9. Laboratory tests: Laboratory tests can help the dermatologist determine if there is any inflammation or infection in the scalp, which can cause hair loss. The dermatologist may also perform a test for high levels of testosterone, which can indicate the presence of hormonal changes that can cause hair loss.
  10. Histopathology: Histopathology is a type of laboratory test that involves examining a small piece of tissue under a microscope. The dermatologist will examine the tissue to determine if there is any inflammation, scarring, or damage to the hair follicles, which can confirm the diagnosis of LPP.

Treatment

The following is a comprehensive list of treatments for LPP:

  1. Topical Corticosteroids: Corticosteroids are anti-inflammatory drugs that are commonly used to treat skin conditions. They can be applied directly to the scalp in the form of a lotion, cream, or ointment. Topical corticosteroids help to reduce inflammation, itching, and redness and may also promote hair regrowth.
  2. Systemic Corticosteroids: Systemic corticosteroids are oral medications that are used to treat severe cases of LPP. They are prescribed when topical corticosteroids are not effective. Systemic corticosteroids can cause serious side effects and should only be used for short periods of time.
  3. Calcineurin Inhibitors: Calcineurin inhibitors are immunosuppressant drugs that are used to treat autoimmune conditions such as LPP. They work by blocking the production of certain immune cells that contribute to inflammation. Calcineurin inhibitors are usually used in combination with topical corticosteroids.
  4. Psoralen plus ultraviolet A (PUVA) therapy: PUVA therapy is a type of light therapy that is used to treat skin conditions such as LPP. Psoralen is a drug that makes the skin more sensitive to ultraviolet light. The patient is exposed to ultraviolet A (UVA) light after taking the psoralen. PUVA therapy can help to reduce inflammation and promote hair regrowth.
  5. Methotrexate: Methotrexate is a chemotherapy drug that is used to treat autoimmune conditions such as LPP. It works by blocking the production of certain immune cells that contribute to inflammation. Methotrexate is usually used in combination with topical corticosteroids.
  6. Cyclosporine: Cyclosporine is an immunosuppressant drug that is used to treat autoimmune conditions such as LPP. It works by blocking the production of certain immune cells that contribute to inflammation. Cyclosporine is usually used in combination with topical corticosteroids.
  7. Dapsone: Dapsone is an antibiotic that is used to treat skin conditions such as LPP. It works by blocking the production of certain immune cells that contribute to inflammation. Dapsone is usually used in combination with topical corticosteroids.
  8. Retinoids: Retinoids are Vitamin A derivatives that are used to treat skin conditions such as LPP. They work by blocking the production of certain immune cells that contribute to inflammation. Retinoids are usually used in combination with topical corticosteroids.
  9. Minoxidil: Minoxidil is a drug that is used to treat hair loss. It works by promoting blood flow to the hair follicles and stimulating hair growth. Minoxidil is usually used in combination with topical corticosteroids.
  10. Platelet-rich plasma (PRP) therapy: PRP therapy is a type of regenerative medicine that uses the patient’s own blood to promote hair growth. Platelets are cells in the blood that contain growth factors that can stimulate hair growth. The patient’s blood is drawn and then processed to concentrate the platelets. The platelet-rich plasma is then injected into the scalp to promote hair growth.
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